Lifestyle measures for treating hypertension

Wilbert S. Aronow

Hypertension needs to be adequately controlled to reduce cardiovascular events and mortality [1–4]. Lifestyle modification should be used to prevent mild hypertension and to reduce the dose levels of drugs needed to control hypertension. Weight reduction, consuming a diet rich in fruits, vegetables, and low-fat dairy products with less saturated fat and total fat, sodium reduction to not exceed 1.5 g daily, smoking cessation, regular aerobic physical activity, avoidance of excessive alcohol intake, avoidance of excessive caffeine, and avoidance of drugs which can increase blood pressure, including nonsteroidal anti-inflammatory drugs, glucocorticoids, and sympathomimetics, are recommended [4, 5]. Implementing a national salt reduction program is a simple and cost-effective way of improving public health [6, 7].
Long-term observational follow-up was performed in 744 persons in the first phase of the Trials of Hypertension Prevention (TOHP I) (10 years after its end) and in 2,382 persons in TOHP II (5 years after its end), in which persons with prehypertension were randomized to sodium reduction or to a usual diet (25–35% greater sodium intake) [8]. In these studies, sodium reduction reduced cardiovascular events by 25%. At 31-month follow-up of 1,981 Taiwanese veterans living in a retirement home, older men randomized to a potassium-enriched diet with 50% less sodium had a 41% decrease in cardiovascular mortality compared with those randomized to a regular salt diet [9].
At 14.8-year follow-up of 12,267 adults in the Third National Health and Nutrition Examination Survey, a higher sodium intake was associated with a 20% increase in all-cause mortality per 1,000 mg of sodium intake per day, whereas a higher potassium intake was associated with a 20% reduction in mortality per 1,000 mg of potassium intake per day [10]. For the sodium-potassium ratio, compared with the lowest quartile, the highest quartile increased all-cause mortality by 46%, cardiovascular mortality by 46%, and ischemic heart disease mortality by 215% [10]. A meta-analysis of 56 randomized controlled trials showed a mean blood pressure reduction of 3.7/0.9 mm Hg for a 100 mmol/day reduction in sodium excretion [11]. Current guidelines suggest no more than 2,300 mg of sodium daily in the general population and no more than 1,500 mg of sodium daily in older persons, in blacks, and in persons with hypertension, diabetes mellitus, chronic kidney disease, or heart failure [12]....